I am a plastic surgeon in Little Rock, AR. I used to "suture for a living", I continue "to live to sew". These days most of my sewing is piecing quilts. I love the patterns and interplay of the fabric color. I would like to explore writing about medical/surgical topics as well as sewing/quilting topics. I will do my best to make sure both are represented accurately as I share with both colleagues and the general public.

Quilts of Valor

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Wednesday, March 30, 2011

This is a difficult post for me to write. As much as I admire the surgeons who are pushing this new advance I found myself bothered by this one. Why?

That’s what I have been asking myself. After all, Linda Lu, 21 year old, is a college student from Orlando, Florida is ecstatic about the new hand -- (quote/photo credit)

"I've already accepted it as my hand since the day I woke up," Linda Lu said during a Monday press conference at Emory University Hospital in Atlanta, where the surgery took place. "But just looking at it, sometimes I still can't believe that it's there... It kind of feels like magic."

Simple enough goal, isn’t it? When playing the “what would I give up game” my hands are never given up easily. I could probably learn to sew with only one hand, but it would be difficult and it would become mostly machine sewing. I could still blog as I could type with one hand – not as fast, but it would get done.

I would not be able to do surgery with one hand, but a hand transplant would not give that back to me anyway. The dexterity would never be good enough.

Linda is reported to have lost her left hand when she was 1 year old. The amputation was done due to complications from Kawasaki disease.

Still I’m left with this uneasy feeling. Most people born with only one hand/arm adjust well. For example, look at the baseball pitcher Jim Abbott.

This healthy young woman will now be placed on anti-rejection medications for life. It will make any pregnancies she has high-risk ones. She will be more susceptible to infections. Some anti-rejection medications increase the risk of cancers.

Just because we can do a procedure doesn’t mean we always should. I hope my uneasiness regarding this one is misplaced. After all, I am getting my information from news articles and not from a discussion with the patient.

7 comments:

Could you explain more fully your discomfort, please? Is it the risk of the anti-rejection medications vs what you see as minimal benefit? Could you explain a bit more about the level of risk? Maybe that's what I'm not understanding? (Because the benefit I imagine would be huge, while I have no concept of the risk, probably.)

Bardiac, I tried to do just that. It's more the risks of the anti-rejection medications in someone who is healthy to begin with. For me, I see those risks as much larger than the benefits in this case. I admit, I may be wrong. A hand (especially to me) is extremely important but not necessary for a full life.

Ramona, I am a musician and use my hands a lot, but I also agree with you. I don't know that I would go through with a hand transplant and the anti-rejection drugs, if heaven forbid something happened.

But through trying to find out what I really suffer from, I cannot say it is "the hand missing" that defines it. It's a part of it and getting the right type of prosthetic replacement was and is a substantial issue. But it's not the end all be all. In the end I will always have to find a compromise or new answers - and selling my immune system health for a crappy bio hand replacement wasn't a deal I was going for here.

I could say that inside that deep depression or at least melancholy that accompanied my limb loss at first, there are recent moments of absent sorrow and free happiness. Since a while these moments are coming back, and they do not relate to "having a hand illusion". Those are the moments I am after! They are happy moments with friends, great moments after swim trainings or competitions that really make my day, being able achieve some work goal as it always cheered me up, reading a good joke, having a great chat with family or friends. And so that is what I emphasize for well being, not a hand transplant.

And I always knew that I am defined by a range of things, and only a few days a month do I really need to wear my plastic arm for a true urge of replacement. These moments really exist, and I feel ashamed of them, but they are not defining or at least I do not admit them to be defining. I say, screw it! Let me see if that stump can be stared down! And I don't let this laughable crippled arm get the better of me. I do not like it on a good day, I hate it on a bad day, and when I am bitter I can make jokes about it. But so what.

With what I saw on documentaries, an average hand transplant works about as well as a somewhat useful prosthetic hand. A really optimized prosthetic hand can be and will be better. I spent three years now, optimizing my prosthetic arm - and I cut hedges using a power saw, I do fine detailed craftswork, I lift heavy boxes when moving, and a range of things not recommended with either an average prosthetic arm with commercial parts, or a transplanted hand. And when I wreck that arm and I admit that I do - off it goes, to get it repaired. Being able to eek out good function is highly satisfying as such.

Two functional properties make prosthetic arms a lot more useful than a transplant - being able to improve, improve, improve, improve, what the prosthetic does for me - and, being able to work on the prosthetic arm, fix it, modify it, and all that while I don't wear it. That is a real relief - do all that off site, pain free, no need for surgery.

Also, my stump as such is functional. People don't believe that it can be but screw that - it is a lot more functional than people believe. I use it to carry out garbage, carry bags, the (sensitive) end allows for rather precise 5 + 1 system speed typing (which is what the lady in the report said she wanted to do). And it looks weird but I get by.

And so right now I just got done passing a serious H1N1 infection through my lungs aided by loads of meat, asparagus, nuts, salad, pasta and water staying home alone looking after myself after doctor told me what to watch out for. The cough syrup I got was left untouched. And of all prosthetics that I miss (being a recovering tired H1N1 swine flu patient) - it is a better coffee mill. Reading your blog, I'm not missing my absent hand nearly as much as I am craving a harmless consumer product.

I'd admit it if it was a hand transplant but being a below elbow amputee, I miss completely other things than a hand transplant. And yes I like my prosthetic arms for what they are. But I'd never ever give up the freedoms that I have doing almost extreme sports, always risking infectious exposure in all kinds of public pools, by allowing a hand transplant and immune supression. That'd be different for a life threatening heart, liver or kidney disease - but we are talking about that hand.

I think, before doing such a procedure they should talk to those who live their lives on these drugs ... get the nitty gritty .. from patients, not text book risks ...

I'd fight tooth and nail to keep my immunosuppressants, but I also know what life was like before, and what it's like now ... but if there was another option that could give me the same quality of life without the risk .. or even CLOSE to the same ... I'd switch.

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